Albany glitch delays pay for special-needs teams

Thousands of therapists who work with special-needs children across the state are fighting to get paid, and in many cases stay in business, during a chaotic state takeover of their bill payments.

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By JOHN SULLIVAN

recordonline.com

By JOHN SULLIVAN

Posted Jul. 29, 2013 at 2:00 AM

By JOHN SULLIVAN
Posted Jul. 29, 2013 at 2:00 AM

» Social News

Thousands of therapists who work with special-needs children across the state are fighting to get paid, and in many cases stay in business, during a chaotic state takeover of their bill payments.

"What seemed manageable at first is becoming less and less manageable as time goes by," said Kim Costa, owner of Katskill Kids, an early intervention agency in Grahamsville.

Costa was referring to the new administrative costs and headaches that providers like her agency have had to take on since April 1, when the new state-managed billing system took effect. Many have not been paid for work they did in April and in some cases even before that.

Costa estimated her agency is owed some $80,000 in outstanding bills from insurers, Medicaid and the state for services.

Worse, under the new payment system, her agency of just 17 employees has had to figure out on the fly the medical billing process formerly handled by the counties and with a new computer system that came without a training manual.

The changes come in addition to a 20-percent reduction in the rate of reimbursements for early intervention services and other cost-cutting and cost-shifting strategies that Gov. Andrew Cuomo and the state legislature put into effect with the adoption of the 2011-2012 state budget.

The governor estimates $60 million of savings to the state over five years from the changes to the state's 19-year-old Early Intervention Program.

Therapists and agencies that provide early intervention services, however, say the program saves $7 to $17 for every dollar spent, because it eliminates or reduces the need for special-needs services for children later in their lives.

They fear the changes are part of a short-sighted attempt to shrink the size of the program. How else, they say, to explain the extremely cumbersome billing process?

In it, independent service providers — most of whom have never been trained in medical billing — must spend dozens of additional hours per week figuring out its complexities.

At the same time, they must also try to get insurance agencies, Medicaid officials and state officials on the phone to work out billing problems.

"It was like, "Here it is, figure it out,'" said Robin Seccafico, president of Dynamic Center, which provides early intervention services to 800 children throughout Orange, Ulster, Sullivan, Dutchess and Rockland counties, and in the five boroughs of New York City.

The center, which has half a million dollars in unpaid bills since April, is luckier than most, because it has a financing agency that fronts the money for payroll and other operational expenses.

"We're big enough and strong enough to stay, but there are great providers in the industry who are leaving because they can't deal with it anymore," she said.

Prior to the changeover, early intervention therapists or agencies reported all their claims to the counties.

The counties then billed Medicaid, private insurers and the state — which picked up about 50 percent of what the insurers did not cover, said Sheila Warren, director of Early Intervention for Orange County.

Orange County received a grant of $300,000 to cover administrative and regulatory oversight of the program, which the counties continue to perform even after the state's billing takeover, Warren said.

Warren acknowledged the difficulty of the process, which required her agency to employ 2.5 full-time equivalent workers to manage.

"It's very cumbersome, and it took a lot of time to learn the nuances," she said.

According to United New York Early Intervention Providers With Parents as Partners, a trade association of 2,500 early intervention agencies, independent contractors and parents, 86 percent of its service providers have received less than 20 percent of their pay on outstanding bills for April, because of glitches in the computer system or problems in the insurance billing.

The same percentage have received nothing for May and June (most have not billed yet for July).

The delayed bill payments come in the wake of consecutive state reimbursement reductions for early intervention services, even as costs, such as gas prices — most therapists make home visits to administer services — and administrative costs continue to skyrocket.

"Truthfully, we're doing twice as much work, and we've had two pay cuts, and this is going to require even more administrative staff. It's bleak," said Pat Howley, owner of Jilly's Place, an early intervention service that has been in Washingtonville for 15 years.

Agencies and individual therapists have contacted the governor's office, the state's Bureau of Early Intervention, which administers the program, and the interim fiscal agent that developed the software — James McGuinness & Associates Inc. of Schenectady. They say they have gotten no answers as to why the transition has been so rocky.

A call to Gov. Cuomo's office was not returned Friday.

Panicked calls from therapists and agencies reached the offices of state representatives, who had few answers about the chaotic transition.

Assemblyman James Skoufis, D-Woodbury, said he was aware the state delayed the billing takeover but was not certain of the reasons behind it.

"Clearly it's not ready now, and being that it's not ready, I will like to see that it gets fixed," he said.

"This is about the survival of small business," said Assemblywoman Aileen Gunther, D-Forestburgh, who said she put in calls to Cuomo's administration about the problems. "You can't run a business when you can't get paid," she said.

Responding to the complaints, officials with the state's Bureau of Early Intervention sent out an email on Friday, suggesting that private insurers were to blame for the payment delays.

Medicaid and the counties have disbursed some $100 million of unpaid claims over the past few months, while private insurers have paid less than 1 percent of the $25 million that have been billed to them, the email said.

To offset the delays, the state will allow service providers with outstanding bills from private insurance firms to receive 75 percent of their unpaid bills as a loan through county governments willing to participate in the emergency payment measure.

However, the providers must agree to pay back the emergency payment by March and accept the 75 percent as total payment.

Like many therapists who received the email Friday, Abigail Greene, owner of Jack & Jill Development Services in Liberty, considered the emergency payment offer a stop-gap measure that failed to get at the crux of the state's administrative problems with the billing.

"It's great if (the Bureau of Early Intervention) is trying to help out, but it can't be a patchwork type of thing, because this whole system is majorly flawed," Greene said.